The purpose of the Supplemental Questionnaire is to determine whether you meet the Minimum Qualifications for the 2324 Nursing Supervisor (Outpatient) position as well as to determine your knowledge, skills and abilities in job-related areas that have been identified as critical for satisfactory performance in this position.
The information provided should be consistent with the information on your employment application and is subject to verification. Verification of education and experience may be collected at any time during or after the selection process so please choose the best answer for the questions below.
1A.
What is the highest degree you have obtained in Nursing?
Associate's of Science Degree in Nursing (ASN)
Bachelor's of Science Degree in Nursing (BSN)
Master's of Science Degree in Nursing (MSN) or higher (i.e. PhD.)
No Degree in Nursing
2A.
Please identify the highest graduate level degree that you possess from the list of disciplines below. If you do not have a graduate level degree in these disciplines, please select "None of the above."
Master's degree in Nursing
Master's degree in Public Health
Master's degree in Public Administration
Ph.D. degree in Nursing
Ph.D. degree in Public Health
Ph.D. degree in Public Administration
None of the above
3A.
Do you possess a valid California Registered Nurse license issued by the California Board of Registered Nursing?
Yes
No
4A.
Do you have a valid Cardiopulmonary Resuscitation (CPR) certificate issued by the American Heart Association (AHA)?
Yes
No
4B.
If you answered “Yes” to question 4A. above, please identify all of the valid AHA CPR certificates that you possess.
Basic Life Support (BLS) for Healthcare Providers
Advanced Cardiovascular Life Support (ACLS)
Pediatric Advanced Life Support (PALS)
Other
4C.
If you answered “No” or “Other” to questions 4A. or 4B. above, please provide an explanation below.
5A.
How much verifiable full-time equivalent work experience do you have in a designated Nursing supervisory capacity (nurse manger or designated charge nurse) or administrative leadership/support role, in a hospital-based or community-based primary care unit or similar ambulatory care/outpatient setting?
I do not have any experience in these areas
I have less than 24 months of experience in these areas
I have between 24 months and 35 months of experience in these areas
I have between 36 months and 47 months of experience in these areas
I have between 48 months and 59 months of experience in these areas
I have more than 60 months of experience in these areas
6A.
In accordance with your response to question 5A. above, how many employees do you have experience supervising? Relevant supervisory experience should include, but not be limited to staff development, performance evaluation, and disciplinary processes.
I have experience supervising fewer than 25 employees
I have experience supervising between 25 to 49 employees
I have experience supervising between 50 to 74 employees
I have experience supervising between 75 to 100 employees
I have experience supervising more than 100 employees
7A.
Do you have knowledge and experience in the application of the following federal and state regulatory and/or accreditation standards? If yes, please select all that apply.
The Joint Commission
California Code of Regulations - Title 22
Centers for Medicare & Medicaid Services
Americans with Disabilities Act (ADA)
Equal Employment Opportunity Commission (EEOC)
I do not have knowledge or experience in these areas.
8A.
How much verifiable full-time equivalent nursing experience do you have working with Maternal, Child & Adolescent populations?
I have no experience in these areas.
I possess 11 months or less of experience in these areas.
I possess between 12 months to 23 months of experience in these areas.
I possess between 24 months to 35 months of experience in these areas.
I possess greater than 36 months of experience in these areas.
I understand that checking this box will serve as my electronic signature. I certify that I am the author of this form and all information presented is true and based upon my work education and/or work experience. I understand that prior to an appointment, I may be required to provide written verification of any of the information provided above and, during the probationary period, I may be required by the hiring department to participate in (a) performance test(s). I further understand that any false, incomplete, or incorrect statement may result in disqualification, dismissal, or termination of employment from the City and County of San Francisco.
Department of Human Resources